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ForEliteAtheletes toFunRunners
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Anyone and everyone can suffer from plantar fasciitis. It
is a debilitating problem that everybody should fear as
it can put you out of action for months on end. Imagine
the horror you would face having to miss a race!
So what is Plantar Fasciitis?
The plantar fascia is a band of connective tissue
(aponeurosis) that runs along the bottom of the foot
to connect the heel bone (calcaneus) to the toes
(metatarsals). It acts to provide arch support to the
foot, whilst also acting as a shock absorber.
Plantar Fasciitis is inflammation of the plantar fascia
tendon, usually at it’s proximal attachment.
How to Treat Plantar Fasciitis
Now this is the part that is most difficult, as everybody
is different and treatment and rehabilitation should
be individualised to each and every one of you. Every
health professional is different but my advice is:
Acute Stage (0-4 weeks):
In this stage we are typically
trying to reduce the inflammation. This can be done
using the RICE protocol and load
management principles (e.g.
reducing the time spent on your
feet including running, using
taping methods to offload the
fascia).
n
REST – This should be relative
to your normal daily activities
n
ICE – Try putting an ice bottle
in the freezer and rolling along the sole of your foot.
n
COMPRESSION – Use KT tape or zinc oxide tape.
n
ELEVATION – Put your feet up!
Sub Acute Stage (4-12 weeks):
At this stage, the pain
and inflammation should have settled sufficiently
enough to start a graded rehabilitation programme.
The aim of this stage is to strengthen the weakened
tissue.
The rehab programme consists of one simple
strengthening exercise, coupled with one stretching
detailed below:
(pictured left)
The strengthening exercise is a unilateral heel raise.
Every heel raise consists of a 3 second concentric
phase (going up), a 2 second isometric phase (pause
at the top of the movement, and a 3 second eccentric
phase (coming down).
This stretching exercise is simply performed by
grasping the toes in one hand and pulling them up,
with the fingers on the point of pain to further stretch.
Weeks 4-6:
3 sets of 12 repetitions with 10 sets of 10
second stretches.
Weeks 6-10:
4 sets of 10 repetitions with 10 sets of
10 second stretches.
Weeks 10-12:
5 sets of 8 repetitions with 10 sets of
10 second stretches.
Chronic Stage (12 weeks+):
If you are unfortunate
enough to reach this stage, it may
be the case that there is something that is preventing
you from achieving your goal. Some adaptations that
can occur with this condition are scar adhesions,
calcification in the tendon, or a calcaneal spur (extra
bone growth from the heel bone)
So what are your options?
Some may suggest a corticosteroid injection, this
will reduce the pain, however some studies have
suggested that these can have a negative effect on
tendon health.
I have used, and found
very successful, shockwave
therapy. This will break
down any adhesions, and
calcification which prevent the
tissue from getting stronger.
This will usually occur once
a week over 3 weeks, followed by the rehabilitation
programme documented above.
In more drastic cases, some people will need surgery
to remove the calcaneal spur, however this should
only be a last resort.
Please be aware that these are suggestions and you
should always consult with a healthcare professional
first before taking on any treatment.
Plantar Fasciitis is
inflammation of the plantar
fascia tendon, usually at it’s
proximal attachment.
HEALTH
avoid the pitfalls of open water
Plantar Fasciitis
You can find me
on twitter:
@TobyPhysio
There are of course many other treatment
options, such as acupuncture, orthotics,
heal raises that may aid your recovery but
first and foremost, don’t self diagnose.
Seek professional advice.
